In 2010 the Superintendent of Health Services (SSS, for its acronym in Spanish) should have collected $2,872,840 following 86 fines for irregularities in social work benefits. However, according to a report by the federal watchdog the healthcare entity "only canceled six –of the sanctions- for $143,642, or 5%" of the total.
Something similar is observed in fines levied in prior years. The investigation of the AGN, passed this year, reveals that of the 105 sanctions imposed by the SSS in 2009, totaling $1,285,758.77, only 51 were charged totaling $353,228.56 (28% of the total). And another 18 were canceled a year later for almost $250,000.
Given such figures, the audit notes that the Superintendent has the authority not only to penalize the Health Care Company, but also has a 2004 decree that enables them to withdraw the money for fines directly from the providers’ accounts.
Moreover, the Super –as it is also known- is also responsible for evaluating the financial statements of the health care companies. Some findings of these studies are summarized in the report of the AGN.
For example, 30% of health care companies recorded medical relief expenses that are lower than those established by Law 23.660 which governs this matter, and 36% of cases show higher ceiling Administrative Expenses provided by the same standard.
In a nutshell, there are health care programs that spend less than the minimum when serving their members and the maximum on administrative matters.
The federal watchdog states that "failure to comply with these terms of investment and expenditure are classified as 'serious' by Law 23,660.”
However, there are other observations: 59% of health care companies have recurrently presented their accounting books "out of the terms established in legislation", and in 21% of cases, the financial statements do not include details on savings accounts, checking accounts, and the CDs health care companies have.
They also "warned disparity between the numbers of beneficiaries informed –in the accounting books- and most Insurance Agents arising from the Superintendence commands. These differences –the AGN continues- were detected for 65% of cases, and influences indicators such as "performance based per capita expenditure."
Among the controls the Superintendence made, the Audit remarks: "It was found that 18% -of the health care companies- will have a difficult financial economy, as evidenced by lack of working capital and poor flow rate and total liquidity. Of the analysis of the financial statements, these are the indicators: Health Care Companies with equity loss, and others in which the expense of each beneficiary is well above average." The AGN completed with another fact: "Approximately 47% of health care companies concentrated only 4% of the beneficiaries, there are some with very little amount of (members) which mean a direct financial vulnerability."